Background: Vertebrobasilar DOLICHOECTASIA is defined as a prominent elongation, dilatation and tortuosity of the vertebral and basilar arteries. Ectatic basilar arteries may cause different neurological symptoms by several mechanisms including compressive effects and embolic or ischemic events.Case presentation: In this report we present a 58-year old female patient who was admitted in Dr. Shariati General Hospital in Tehran, Iran with complaints of dysarthria, vertigo, ataxia and nausea. Neuro-imaging procedures (brain CT scan, CT angiography, and an MRI study of the blood vessels or MRA) were performed. Dilation and elongation, as well as tortuosity of the vertebral and basilar arteries revealed the diagnosis of vertebrobasilar DOLICHOECTASIA. The patient was discharged from the hospital following the control of underlying diseases and neurological symptoms related to DOLICHOECTASIA without undergoing any invasive procedures.Conclusion: Paying attention to any minor or major neurological symptoms, as well as underlying medical conditions along with the conservative control of symptoms can be most helpful. Invasive interventions in a chronically ill patient can be very risky, therefore, medical management including control of associated or underlying diseases is recommended as the first line of treatment.

BACKGROUND: Vertebrobasilar DOLICHOECTASIA (VBD) is a rare vasculopathy. The etiology of this disease is unknown. Transient ischemic attacks (TIAs) of vertebrobasilar system refer to a transient (<24 hours) lowering of blood flow in the posterior circulation of the brain. We present a case of DOLICHOECTASIA in the vertebrobasilar artery that presented with TIAs.CASE REPORT: A hypertensive 54-year-old man with true vertigo, nausea, imbalance, dysarthria, dysmetria, horizontal nystagmus, and gait ataxia was referred to Alzahra Hospital, Isfahan, Iran.The symptoms improved in the 1st day, but recurred in the 2nd day, lasting for 6-7 hours. According to clinical manifestations, a diagnosis of TIAs in the vertebrobasilar circulation was made. Imaging studies showed vascular anomaly. The vascular anomaly was considered as the cause of the patient’s symptoms. A medical management was started using antiplatelet and antihypertensive drugs. The patient was referred for a more evaluation for other vascular anomalies.CONCLUSION: DOLICHOECTASIA usually affects vertebral and basilar arteries and simultaneous involvement of carotid arteries is rare seen in only 0.5% of these patients. The usual symptom of DOLICHOECTASIA is ischemia and rarely hemorrhages. The most common type of ischemic stroke is lacunar type. Ischemia evolves from embolic that originate from thrombi or plaques in the walls of the ectatic artery. While hemodynamic effects are the most common cause of the presenting signs and symptoms of the anomaly. We report a case of DOLICHOECTASIA that presented with TIAs of the verterbrobasilar artery. VBD is a distinct arteriopathy known as stroke risk.

Vertebrobasilar DOLICHOECTASIA or dilatation and elongation of the vertebrobasilar arterial system are uncommon vascular anomalies without clearly defined etiology. There are different hypotheses such as arteriosclerosis and accelerated hypertension or congenital defects regarding pathogenesis of this condition.Here we present two cases of vertebrobasilar DOLICHOECTASIA in association with anomalous hypoplastic left vertebral artery in support of its congenital cause with a review of imaging in the evaluation of this potentially severe vasculopathy.

Background and purpose: The complexity of anatomical variation of Willis circle (CW) has made it susceptible to variation. The goal of this study was to determine the prevalence of the CW variations using magnetic resonance angiography (MRA) without contrast agent in patients attending Sari Imam Khomeini Hospital.Materials and methods: In a cross-sectional study, 200 subjects referring for MRA were analyzed. Variables included hypoplasia, agenesis, stenosis, aneurysm, DOLICHOECTASIA, fenestration and duplication. Logistic regression model was applied to estimate the association between variation states in CW and other variables.Results: The most common variation was hypoplasia in left and right posterior communicating arteries (n=118 (59.3%) and n=107 (54%), respectively). Stenosis and DOLICHOECTASIA were more prevalent in anterior cerebral artery and basilar artery, respectively. Among the participants 90 (45%) were diagnosed with stenosis and 31 (15.5%) were reported to have DOLICHOECTASIA.Conclusion: Typical circles were seen only in 28 (14%) individuals and the rest had other variations. Therefore, MRA could be beneficial for diagnosis, treatment and prognosis.

Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Unruptured aneurysms may cause symptoms mainly due to a mass effect, but the real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage. Most aneurysms are asymptomatic and will not rupture, but they grow unpredictably and even small aneurysms carry a risk of rupture. There are many risk factors for the development of intracranial aneurysms, both inherited and acquired. Females are more prone to aneurysm rupture, with subarachnoid hemorrhage (SAH) 1.6 times more common in women. The prevalence of aneurysm increases in certain genetic diseases. There are four main types of intracranial aneurysms: saccular, fusiform (atherosclerotic or dolichoectatic type/congenital type), dissecting, and the mycotic type. The saccular type accounts for 90% of intracranial aneurysms. We observed some patients who were referred for diagnosis and further angiographic evaluation. They had presented with various histories and clinical findings. Their imaging findings such as CT scan, CTA, MRI and MRA findings were unusual. Every one of these patients has an uncommon form of aneurysm which could be misdiagnosed with other conditions or might need special and different treatment and knowledge of these situations could be of great help.